CS000000-A | 07/26/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 12 | July 26, 2021 | Date Range: June 21, 2021 – July 12, 2021

Summary

Findings. Consumer concerns about the safety of COVID-19 vaccines were amplified by multiple, overlapping 

and widely circulating misinformation narratives. As a result, some consumers questioned the transparency of the 

government in reporting and addressing adverse events following COVID-19 vaccination. The Delta variant of the virus 

that causes COVID-19 continues to drive concerns about vaccine effectiveness, especially among those who are already 

vaccinated. However, those who remain unvaccinated are generally less likely to perceive the Delta variant as a threat, 

and vaccine intentions do not appear to be affected. 

Ways to take action. Federal, state, and local partners should continue to work together to increase transparency 

around rationale for updated guidance, respond to gaps in information, and confront misinformation with evidencebased messaging. The goal of these efforts is to increase confidence in COVID-19 vaccines and expand vaccine uptake 

more broadly. Messages leveraging available data on vaccine safety and effectiveness should be disseminated, 

especially in relation to the Delta variant and circulating misinformation narratives. Public health agencies should 

partner with trusted messengers and healthcare personnel to further amplify these messages. Research efforts should 

be supported to further evaluate the effect of reported adverse events, side effects, and vaccine effectiveness on 

vaccination intent and motivation.

Contents

2 Aims and Methods

3 Consumer concerns about the safety of COVID-19 vaccines were 

fueled by overlapping misinformation narratives. 

4 Vaccinated consumers are concerned about vaccine effectiveness 

against the Delta variant while unvaccinated consumers remain mostly 

unconcerned about the variant’s spread. 

5 Some consumers claim a COVID-19 treatment is being suppressed to 

unnecessarily promote vaccination.

5 Consumers need answers about the safety and effectiveness of 

Johnson & Johnson’s Janssen COVID-19 Vaccine. 

6 Some consumers are angered by the announcement of new 

“door-to-door” vaccination outreach efforts.

7 Update on Special COVID-19 State of Vaccine Confidence Insights 

Report on the Authorization & Recommendation of the 

Pfizer-BioNTech COVID-19 Vaccine for Adolescents Aged 12 through 

15 Years

8 Continuing and Evolving Themes

9 Appendix: Inputs and Sources

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence & Demand Team, Insights Unit

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
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COVID-19 State of Vaccine Confidence Insights Report | Report 12 | July 26, 2021

Aims and Methods

By rapidly reviewing and analyzing numerous sources and inputs (see Appendix), the biweekly COVID-19 State of Vaccine 

Confidence Insights Report emphasizes major themes that influence COVID-19 vaccine hesitancy and uptake. These are 

characterized by level and type of threat to vaccine confidence, degree of spread, and directionality. By examining how 

consumers think and feel, social processes, and the practical issues around vaccination, the Insights Report seeks to identify 

emerging issues of misinformation, disinformation, and places where intervention efforts can improve vaccine confidence 

across the United States.

The information in this report is only a snapshot, and certain populations may be underrepresented. Images and quotes are 

illustrative examples and are not meant to be comprehensive of all content related to the highlighted themes. 

Theme Classification

How do you classify this theme/information? 

High risk Moderate risk Low risk Positive sentiment

 May lead to vaccine 

refusals and decreased 

uptake 

 Wide reach, pervasive  

 Potential to trigger 

hesitancy to vaccination

 Moderate reach, modest 

dissemination 

 Concerning, but low risk 

to vaccine confidence 

 Limited reach, limited 

dissemination 

 Could increase vaccine 

confidence, intent, or 

motivation

 Variable reach and 

dissemination

How has this theme/idea changed over time (since last report or over the course of multiple reports)? 

Increasing

Information spreading rapidly 

Stable

Information remaining 

constant at prior level 

Decreasing

Information is not gaining further 

traction and there has been no 

indication of additional activity 
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COVID-19 State of Vaccine Confidence Insights Report | Report 12 | July 26, 2021

Major Themes

Consumer concerns about the safety of COVID-19 vaccines were fueled by 

overlapping misinformation narratives.

Throughout the reporting period, vocal vaccine deniers circulated and amplified several misinformation narratives focused on 

discrediting the safety of COVID-19 vaccines. Major circulating false narratives included:

 False claims that Pfizer-BioNTech COVID-19 Vaccine contained graphene oxide, a supposedly poisonous ingredient, which 

can cause damage to immune systems, pneumonia, and vascular injury.1,2,3

 False claims that mRNA COVID-19 vaccines are “cytotoxic” and cause the body to produce spike proteins, which collect 

within organs causing damage, particularly to the ovaries.4,5,6

 COVID-19 vaccination disrupts menstrual cycles and has caused increased miscarriage rates.7,8

 A retracted journal article from Vaccines that falsely reported that for every three COVID-19 deaths prevented by 

vaccination, two injuries were caused. These claims continued to circulate despite the article being retracted.9,10,11

These narratives entered a digital landscape primed with concerns 

about the safety of COVID-19 vaccines as consumer fears about 

myocarditis and pericarditis following vaccination remained at top of 

mind for many.12,13,14,15Consumer fears about vaccine safety were then 

further fueled by FDA adding a warning on July 12, 2021, about cases of 

Guillain-Barré syndrome occurring following vaccination with Johnson 

& Johnson’s Janssen COVID-19 Vaccine.16,17,18Consumers sought answers 

online for information about these safety concerns with online searches 

for “spike protein,” “graphene oxide,” and “covid vaccine miscarriage” 

increasing throughout the reporting perioda and searches for “guillain 

barre” increasing significantly from June 2021 to July 2021.b

With the large volume of misinformation narratives circulating, vocal 

vaccine deniers, and some consumers questioned the transparency 

of the government in reporting and addressing adverse events 

following COVID-19 vaccination.19,20,21,22 In addition to lack of trust in the 

government, recent polls and studies confirm that among those who 

remain unvaccinated the most common cited reasons are concerns 

about the safety of vaccines and their side effects.23,24 

Ways to act: 

 Continue to disseminate messages about the safety of COVID-19 vaccines, highlighting the number of people who were 

vaccinated without adverse events and promoting awareness of the multiple layers of safety monitoring systems in place. 

Amplify messages about what Vaccine Adverse Event Reporting System (VAERS) is, how all the safety monitoring systems 

work, and how reported adverse events are investigated.

 Expand available online content to debunk widely circulating myths and misinformation, and ensure that web content is 

optimized for search engines. 

 Partner with healthcare personnel, especially women’s health providers, to address misinformation clearly and transparently 

about COVID-19 vaccines, fertility, and reproductive health.

 Support research to better understand consumer perception of vaccine safety, how they seek information about vaccine 

safety, and who are trusted sources for vaccine safety information.

a

Google Trends

b

SEMrush
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COVID-19 State of Vaccine Confidence Insights Report | Report 12 | July 26, 2021

Vaccinated consumers are concerned about vaccine effectiveness against the 

Delta variant while unvaccinated consumers remain mostly unconcerned about 

the variant’s spread. 

News coverage of the Delta variant of the virus that causes COVID-19 continued to increase from the last report. c

Coverage ranged from the Delta variant becoming the most common cause of COVID-19 cases in the United States25 to 

conflicting reports about whether additional doses would be needed as a result.26,27,28,29Despite a joint statement from CDC 

and FDA clarifying that additional doses are not recommended at this time for fully vaccinated individuals, some vaccinated 

consumers continued to question whether an additional dose will be needed to better protect themselves against emerging 

variants, including Delta.30,31 Several vaccinated consumers also expressed frustration online that unvaccinated consumers are 

posing a threat to the return to pre-pandemic life and the health and safety of people who are unable to be vaccinated, such as 

children under 12 years old.32,33,34At the same time, several consumers called for mitigation measures, such as mask mandates, to 

return, even for the fully vaccinated to help slow the spread of the Delta variant.35,36

Concern about the spread of the Delta variant appears to be far less 

common among those who are not vaccinated than it is among those 

who are already vaccinated. One recent poll found that almost half 

of adults with no plans to get vaccinated were not worried about the 

Delta variant and almost one-third of adults not currently vaccinated 

were also not worried.37 Throughout the reporting period, vocal vaccine 

deniers amplified narratives that the Delta variant is less serious38,39 and, 

in some cases, not even real.40,41,42 Other vocal vaccine deniers spread 

misinformation that those who are vaccinated were at increased risk 

for severe illness from the Delta variant 43,44 and that vaccinated people 

caused the emergence of variants of the virus that causes COVID-19.45,46

Confusion about the effectiveness of available vaccines against the Delta 

variant was widespread. Consumers and news outlets online noted data 

from Israel that suggests vaccines are less effective against the Delta 

variant than previously believed.47,48,49,50 Consumers also inquired online 

if a particular vaccine was more effective against the Delta variant, with 

several indicating they believed authorized vaccines do not provide any protection against this variant.51,52 However, concerns 

about variants were not limited to the Delta variant; the frequency of news coverage and online conversations during this 

period also increased about the “Delta plus” variant and Lambda variant.53,54,55,56

Ways to act:

 Disseminate messages about the effectiveness of available COVID-19 vaccines against the Delta variant and other circulating 

variants in the United States. Continue to amplify messages about the benefits of vaccination, such as reducing the likelihood 

of severe illness causing hospitalization or death from COVID-19.

 Continue to partner with trusted messengers to amplify messages about the severity of COVID-19 illness and the benefits 

of vaccination, leveraging recent data that show a majority of people hospitalized for or dying from COVID-19 are not 

vaccinated. 

 Evaluate how potential availability and authorization of additional doses affects intent to vaccinate or re-vaccinate among 

different consumers.

c

Meltwater

Source: https://today.yougov.com/topics/politics/articles-reports/2021/06/30/unvaccinated-americans-are-notworried-about-delta
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COVID-19 State of Vaccine Confidence Insights Report | Report 12 | July 26, 2021

Emerging Themes

Some consumers claim a COVID-19 treatment is being suppressed to 

unnecessarily promote vaccination. 

Consumers on social media increasingly claimed that a COVID-19 

“cure,” ivermectin, is being “suppressed” by government agencies 

to promote vaccination.57,58,59,60,61 This claim was further amplified 

by a former vaccine developer from a pharmaceutical company 

who has perpetuated a number of misinformation narratives over 

the past few months62 as well as other prominent misinformation 

outlets and vocal vaccine deniers.63,64,65 While there has been 

minimal coverage by mainstream news outlets,66,67,68 the University of 

Oxford announced on June 23, 2021, that it had begun investigating 

ivermectin as a potential treatment for COVID-19.69 The narrative 

around ivermectin appears to recycle earlier false claims about the 

hydroxychloroquine as a treatment.70

Ways to act: 

 Continue to disseminate messages that vaccination is one of the many tools that we are using to help end the COVID-19 

pandemic. 

 Develop and disseminate content about research efforts for treatments of COVID-19 and what is known about available 

effective treatments in addition to promoting vaccination.

Consumers need answers about the safety and effectiveness of Johnson & 

Johnson’s Janssen COVID-19 Vaccine. 

Following the release of results from a recent study suggesting that mixing 

mRNA and adenovirus-based COVID-19 vaccines provided a good immune 

response,71 experts speculated about whether people who have previously 

received a J&J/Janssen vaccine should receive an additional dose of an 

mRNA COVID-19 vaccine.72,73,74 Prompted by the results from this new study 

and the Delta variant continuing to spread across the United States, some 

consumers inquired whether they should receive a dose of mRNA COVID-19 

vaccine to improve their level of protection.d,75,76 Some consumers also 

expressed concern about the safety of J&J/Janssen vaccine, with cases of 

Guillain-Barré syndrome after vaccination gaining news media coverage in 

early July.77,78,79,80 On July 12, 2021, the FDA added a warning about cases of 

Guillain-Barré syndrome occurring following vaccination with J&J/Janssen 

vaccine. Additionally, some consumers who received the single-dose J&J/

Janssen vaccine expressed frustration about the lack of messaging from 

health authorities on J&J/Janssen vaccine, compared to the volume of messages about mRNA COVID-19 vaccines.81,82,83

Ways to act:

 Disseminate messages about J&J/Janssen COVID-19 Vaccine, leveraging available safety and effectiveness data. 

 Clarify what research is being done to evaluate additional doses for those who received J&J/Janssen vaccine. 

d

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 12 | July 26, 2021

Some consumers are angered by the announcement of new “door-to-door” 

vaccination outreach efforts.

As President Biden’s goal of vaccinating 70% of U.S. adults by July 4, 2021, drew 

closer, news coverage increased about the likelihood of missing this goal.84,85 On 

July 6, 2021, the White House announced a tactical shift to increase COVID-19 

vaccination by bringing vaccines directly to low vaccination coverage areas.84 Some 

consumers reacted negatively to this news, claiming that such direct government 

action impinges on their liberty and self-determination.86,87,88,89 Some vocal vaccine 

deniers and politicians falsely claimed that the federal government would send 

“strike teams” across the country to coerce or even forcibly vaccinate adults 

and teens.90,91,92,93,94 According to a recent poll, lack of trust in the U.S. government 

remains a major reason why 38% respondents remain unvaccinated.95

Despite the White House clarifying that “door-to-door” canvassing is similar 

to census-taking or a voter registration drive and just one element in a five-part 

strategy to improve vaccine availability, misinformation outlets and vocal vaccine 

deniers seized on the phrase “door-to-door.”96,97,98 Some consumers expressed 

confusion and dismay online that communities are being identified and questioned 

whether the federal government was secretly tracking individuals’ vaccination status; 

others attempted to draw parallels with historical human rights abuses.99,100,101 Some 

consumers felt that outreach might be an invasion of medical privacy if individuals 

are asked about their vaccination status,102,103 and state-level medical freedom 

Facebook groups leveraged these fears to further amplify their claims of medical 

overreach, especially regarding vaccination.104,105,106  

Ways to act:

 Partner with trusted messengers within communities to amplify messages about vaccination efforts, share how local health 

departments are making vaccination more convenient than ever, and promote the benefits of vaccination. 

 Support research to better understand localized vaccination behaviors and trust in the United States vaccination program. 

Perform message testing to better understand message framing needs for reaching specific communities and demographics. 
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COVID-19 State of Vaccine Confidence Insights Report | Report 12 | July 26, 2021

Update on Special COVID-19 State of Vaccine Confidence Insights Report on the 

Authorization & Recommendation of the Pfizer-BioNTech COVID-19 Vaccine for 

Adolescents Aged 12 through 15 Years

As the Delta variant of the virus that causes COVID-19

becomes more prominent in the United States, 

consumers continue to be divided about the urgency 

at which to vaccinate adolescents and children, 

if a COVID-19 vaccine is authorized for children 

under 12 years old.107,108,109 Some consumers remain 

confused about children’s risk of COVID-19, both 

about the risk of severe illness and how easily children 

could spread the virus.110,111,112 Some parents who 

support vaccination expressed concern over the 

increasing number of cases among children113,114

and felt population immunity would not be possible 

without vaccinating more adolescents and eventually 

children.115 Parents of children too young for 

vaccination specifically asked for more information 

about when children 11 years old and younger would 

be able to get vaccinated,116,117,118 especially as several 

schools announced they would not be requiring 

masks for students in the fall.119,120

On the other hand, some parents who do not support adolescent and child vaccination amplified messages about adverse 

events following vaccination among teens,121,122 with myocarditis and pericarditis following vaccination continuing to be 

their paramount concerns.123,124,125 Many of these parents expressed the belief that the risk for side effects or an adverse event 

following vaccination was greater than the marginal risk of severe illness from COVID-19.126,127 These comments from parents 

and vocal vaccine deniers were met with support from some political leaders who feel children are not at risk and do not 

need to be vaccinated, with many citing the updated World Health Organization (WHO) guidance as justification.128,129,130

Misinformation also circulated among vocal vaccine deniers that health departments were seeking to vaccinate adolescents 

without parental consent, furthering distrust in the United States vaccination system for some parents.131,132,133

Recent polls also highlighted a divide in attitudes among parents about risk of COVID-19 in adolescents versus younger 

children. One poll found that even though four in 10 parents said their adolescent received at least one dose of COVID-19 

vaccine, five in 10 did not plan to vaccinate their child.134 However, a different poll found that more than half of those surveyed 

with children 12 through 17 years old planned to fully vaccinate them, while the majority of those who did not plan to fully 

vaccinate their child indicated they were waiting on more research about the safety of COVID-19 vaccines.e

e Harris Poll for CDC

Source: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccinemonitor-june-2021/

Source: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-june-2021/ 
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COVID-19 State of Vaccine Confidence Insights Report | Report 12 | July 26, 2021

Continuing and Evolving Themes 

Themes below have been noted in previous reports and continue to undermine vaccine confidence. The information highlighted below focuses on what is new or different from previous reports. For additional context and previous recommendations on these themes see previous Insights Reports.

Breakthrough cases. News coverage continues to highlight breakthrough cases of COVID-19 among fully vaccinated people, 

including among high-profile athletes.135,136 Severe illness from COVID-19 among fully vaccinated people, resulting in hospitalization or death, received the most prominent coverage.137,138 This coverage drove concerns for some consumers about the 

effectiveness of available vaccines,139,140 asymptomatic spread by vaccinated people,141,142 and how breakthrough cases are 

counted.143,144 Several consumer concerns on this topic were directly linked to the circulating Delta variant of the virus that 

causes COVID-19.

People with compromised immune systems. Several consumers continue to comment online about a lack of guidance and 

support for immunocompromised people related to COVID-19 vaccination.145,146,147 At the same time, news coverage highlighted the conflicting information consumers were seeing regarding the need for and timing of a potential third dose for 

immunocompromised people.148,149,150

Vaccine administration issues. CDC-INFO continues to field consumer inquiries about foreign vaccination and mixing vaccine brands. People who received an initial vaccine dose abroad are unsure if they should begin a new vaccination series or 

whether they are considered fully vaccinated if the vaccine series they received is not authorized in the United States. Other 

consumers sought guidance on mixing vaccine brands for those who had a reaction to the initial dose or whether they would 

be considered fully vaccinated if they received two doses of different COVID-19 vaccines. 
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COVID-19 State of Vaccine Confidence Insights Report | Report 12 | July 26, 2021

Appendix: Inputs and Sources

Type Input Cadence Sources Tactics for Utilization

Social Media 

Listening 

& Media 

Monitoring

Communication Surveillance 

Report

Daily on 

weekdays

Google news

 Meltwater

CrowdTangle

Native platform searches

 Share of voice topic analysis to identify themes

 Emerging topics 

Meltwater Daily  Facebook, Twitter, Instagram

 Blogs

News media

Online forums

 Share of voice topic analysis

 Emerging theme topics

Identify high reach/velocity topics

CDC Social Meida Channel 

COVID-19 Comment 

Analysis

Daily on 

weekdays

Native platform searches  Sentiment analysis

Identify message gaps/voids

Direct 

Reports

CDC-INFO Metrics Weekly CDC-INFO inquiry line list

 Prepared response (PR) usage report

 Cross-compare PR usage with inquiry theme 

analysis

 Sentiment analysis

Identify information gaps/voids

Vaccine Task Force Media 

Requests

Weekly  Media request line list  Leading indicator for news coverage

Identify information gaps/voids

Web Metrics Weekly  Top pages

Google search queries

 Top FAQs

 Referring domains

Identify information gaps/voids,

Identify keywords/search terms, changes in web 

traffic

Research

Poll Review Weekly Harris Poll, PEW research, Gallup Poll, 

Kaiser Family Foundation 

New data related to vaccine 

hesitancy

Identify socio-behavior indicators related to 

motivation and intention to vaccinate 

Literature Review Weekly  PubMed, LitCovid, ProQuest Central 

New data related to vaccine 

hesitancy

Identify current vaccination intention

Identify barriers to vaccination

Third Party 

Reports

Tanaq Social Listening 

+Media Monitoring Report

Weekly  Meltwater

 Sprout Social

 First Draft

Native platform searches

 Trending topics

Demographic and geographic conversation 

monitoring

CrowdTangle content 

insights report

Biweekly  Facebook  Top pages (voices), groups

General trends/sentiment analysis

News analysis through posts

First Draft News Vaccine 

Misinformation Insights 

Report

Monthly  Proprietary methods  Media trends analysis

 Emerging threats and data deficits

Online vaccine narratives

Project VCTR Weekly  Proprietary methods National and regional trends in negative 

attitudes toward vaccination

Conversations around Legislation

Virality Project Weekly  Proprietary methods  Mis- and disinformation trends related to 

COVID-19 vaccine